- 作者：Amir S. Jadidi ; Hubert Cochet ; Ashok J. Shah ; Steven J. Kim ; Edward Duncan ; Shinsuke Miyazaki ; Maxime Sermesant ; Heiko Lehrmann ; Matthieu Lederlin ; Nick Linton ; Andrei Forclaz ; Isabelle Nault ; Lena Rivard ; Matthew Wright ; Xingpeng Liu ; Daniel Scherr ; Stephen B. Wilton ; Laurent Roten ; Patrizio Pascale ; Nicolas Derval ; et al.
- 关键词：ablation ; atrial delayed enhancement ; atrial fibrillation ; atrial fibrosis ; complex fractionated atrial electrogram ; cycle length ; MRI ; pulmonary vein isolation
- 刊名：Journal of the American College of Cardiology
- 出版年：2013
- 出版时间：27 August, 2013
- 年：2013
- 卷：62
- 期：9
- 页码：802-812
- 全文大小：2116 K
Objectives
This study sought to evaluate the relationship between fibrosis imaged by delayed-enhancement (DE) magnetic resonance imaging (MRI) and atrial electrograms (Egms) in persistent atrial fibrillation (AF).Background
Atrial fractionated Egms are strongly related to slow anisotropic conduction. Their relationship to atrial fibrosis has not yet been investigated.
Methods
Atrial high-resolution MRI of 18 patients with persistent AF (11 long-lasting persistent AF) was registered with mapping?geometry (NavX electro-anatomical system (version 8.0, St. Jude Medical, St. Paul, Minnesota)). DE areas were categorized as dense or patchy, depending on their DE content. Left?atrial Egms during AF were acquired using a high-density, 20-pole catheter (514 ¡À 77 sites/map). Fractionation, organization/regularity, local mean cycle length (CL), and voltage were analyzed with regard to?DE.
Results
Patients with long-lasting persistent versus persistent AF had larger left atrial (LA) surface area (134 ¡À 38 cm2 vs.?98?¡À?9 cm2, p?= 0.02), a higher amount of atrial DE (70 ¡À 16 cm2 vs. 49 ¡À 10 cm2, p?= 0.01), more complex?fractionated atrial Egm (CFAE) extent (54 ¡À 16 cm2 vs. 28 ¡À 15 cm2, p?= 0.02), and a shorter baseline AF CL (147 ¡À 10 ms vs. 182 ¡À 14 ms, p?= 0.01). Continuous CFAE (CFEmean [NavX algorithm that quantifies Egm fractionation]?<80 ms) occupied 38 ¡À 19 % of total LA surface area. Dense DE was detected at the left posterior left atrium. In contrast, the right posterior left atrium contained predominantly patchy DE. Most CFAE (48?¡À 14 % ) occurred at non-DE LA sites, followed by 41 ¡À 12 % CFAE at patchy DE and 11 ¡À 6 % at dense DE regions (p?= 0.005 and p?= 0.008, respectively); 19 ¡À 6 % CFAE sites occurred at border zones of dense DE. Egms were less fractionated, with longer CL and lower voltage at dense DE versus non-DE regions: CFEmean: 97 ms versus 76 ms, p?< 0.0001; local CL: 153 ms versus 143 ms, p?< 0.0001; mean voltage: 0.63 mV versus 0.86 mV, p?< 0.0001.
Conclusions
Atrial fibrosis as defined by DE MRI is associated with slower and more organized electrical activity but with lower voltage than healthy atrial areas. Ninety percent of continuous CFAE sites occur at non-DE and patchy DE LA sites. These findings are important when choosing the ablation strategy in persistent AF.